Chapter 24 Is Concerned With the Treatment of the Polypus That Grows in

the nose. The various kinds (including cancer growth), shapes, and colors of this type tumor and its treatment by surgery or medicine are described. A hollowed nose-dropper made of metal in the shape of a small kerosene lamp is suggested (fig. 9). The dropper is held by its handle while its contents are heated before use. Applying heat to nose drops was probably proposed because it serves two purposes: it allows easier flow of the "duhn," or the fatty substance used, and it raises the temperature of the drops to that of the body.

In his discussion on dental hygiene, al-Zahrāwī describes scrapers and dental forceps for teeth cleaning and extraction (figs. 10, 11) and brings in a few points of historical interest. He warns of the common error of extracting the adjacent healthy tooth instead of the ailing one due to the patient’s sense deception. For a gargle he prescribes salt water, vinegar, and wine (sharāb). To stop hemorrhage he used blue vitriol (al-zāj)--copper sulfate in our modern terminology.

In chapter 33 al-Zahrāwī discusses bridge-making for the consolidation of shaky teeth (fig. 12). He prefers the use of stable gold over silver which, he says, putrifies and rots in a short time. In a rational approach, he also suggests that the fallen tooth itself, or a similar one shaped out of a cow’s bone, be installed and connected with adjacent, stable teeth by a bridge.

Now, turning to chapter 36, we find al-Zahrāwī describing a knife-thin tongue depressor (fig. 13) that he used to facilitate the examination of inflamed tonsils and other swellings of the throat; it was made of silver or copper. And in chapter 37 (chapter 34 in Bes. 503), he describes the excision of an inflamed uvula by surgery. In the same chapter, he also mentions the use of instruments made of steel. Of pharmaceutical interest is the following free translation of the formula he prescribes "as a milder treatment by fumigation ... to be resorted to only when the swelling is subsiding":

Take pennyroyal [Mentha pulegium Linn.], absinthe [Artemisia maritima Linn.], thyme, rue, hyssop, camomile, abrotanum [Artemisia abrotanum Linn.], and other similar herbs. Put all in a casserole and cover them with vinegar. Then close tightly with clay [lutum-sapientiae]--except for a small hole in the middle of the cover--and boil. Connect one end of a hollowed instrument, a crude form of an inhaler [fig. 14], with the hole in the cover and insert the other end, which contains the nozzle, into the patient’s mouth, allowing the vapor to rise up to the uvula. And if you are not able to secure this instrument, take a straw and attach its end to an egg-shell. The egg-shell will prevent burns in the patient’s mouth that might be caused by the heated vapor.

Al-Zahrāwī repeats in chapter 53, on cancer, what Greek physicians had said earlier, that cancer could be removed by surgery only at its first stage and when found in a removable part of the body, such as the breast. Therefore, he confesses that neither he nor any one else he knew of ever applied surgery with success on advanced cancer.

Of special interest in chapter 59 is the metallic "syringe" (fig. 15) used to inject medicinal solutions into the bladder: "The hollow passage [of the syringe] should be exactly equal to the plunger it contains and no more, so that when such fluids from an excess of humors are aspirated they will be drawn out, and likewise when the solutions are injected they will be pushed in easily." Such description of the use of a "bladder syringe" in the late 10th century clearly points to the practical and interesting approach to surgery in al-Taṣrīf. Moreover, his description of the removal of a stone from the bladder--an operation we now call lithotomy--is considered a contribution to bladder surgery.

One of the earliest recorded operations for the extractions of two dead fetuses from the womb is clearly described in chapter 76. The account of this case shows not only al-Zahrāwī’s intelligent approach as a shrewd observer but also his clinical and surgical ability.

Drawings of bulb-syringe instruments used for administering enemas in ailments of the rectum and for the treatment of diarrhea and colic are depicted in chapter 83. The text describes several kinds of syringes made of silver, porcelain, and copper in various sizes (fig. 16). Of particular interest is an illustration of a syringe, especially recommended for children, to which a piece of leather (jildah) is attached (fig. 17). This instrument is a precursor of our modern bulb syringe.

In chapter 84 al-Zahrāwī turns to the treatment of various wounds. He prescribes the following powder formula for use: "Take olibanum [frankincense] and dragon’s blood, two parts of each, and three parts of slaked or unslaked lime. Pound them well, pass through a sieve and apply the powder to the wound." In cases of damaged blood vessels, he tied the arteries by ligature, a practice of which he was a pioneer. In another chapter he describes four methods for suturing the intestines.

Al-Zahrāwī, being associated with war casualties and writing his treatise about the end of the 10th century, no doubt had the experience of dealing with cases involving injuries caused by arrows. The text in